BOSTON — In one of his many television ads, Republican presidential candidate Mitt Romney boasts of his can-do management as governor of Massachusetts.
"In the most liberal state in the country," the ads say, "in the toughest place, Mitt Romney's done the toughest things."
In another, Ann Romney says proudly of her husband, "Every place that Mitt has gone, he has solved problems that people said were nearly impossible."
Yet Romney's ads do not mention what is arguably his most impressive accomplishment as governor: pushing through universal health care for state residents.
He does talk about his health care success when asked in debates and town hall meetings. But he hasn't highlighted it in his ad campaign and doesn't even come close to suggesting that he would do for the country what he did for Massachusetts.
That he doesn't push the plan says something about both policy and politics:
The dream of health care for all has stirred Democrats from Harry Truman to Bill Clinton to this year's crop of Democratic presidential contenders.
Yet of all the people seeking the White House, the only one who has negotiated and signed into law a plan to provide health care to all of the uninsured is Romney.
The plan went into effect in Massachusetts on July 1, and, despite some startup problems, is popular in the state and has become a model for as many as 26 other states.
"It's the only plan in the country that's trying to actually get close to universal coverage," said Robert Blendon, a professor of health policy at Harvard University. "I believe two years from now they will have the bulk of the uninsured signed up."
Where others have tinkered around the edges by expanding programs, Romney and the Democratic Massachusetts Legislature took the bold step of ordering everyone in the state to get insurance.
To help, the state will offer subsidies to many uninsured. The state also negotiated new policies with lower premiums.
Much of the money comes from a fund already used to finance emergency room care for the uninsured. More comes from a federal grant, and the rest from the state.
Despite complaints about confusion and kinks in the system, the people of Massachusetts like it even more than they did a year ago. Governors and legislators from other states are calling to find out more.
Yet voters in the early caucus and primary states such as Iowa, New Hampshire, South Carolina and Florida hear nothing about it in Romney's ads, which have aired more than all the ads combined from all the other campaigns in both parties.
One reason could be that Republicans don't like the idea of the government ordering people to buy insurance.
"He doesn't talk about it because that feature is not that appealing to Republican voters," said Blendon, noting a poll on the subject conducted by Harvard and the Kaiser Family Foundation.
The poll also found that Republicans are less interested in health care as an issue than Democrats.
"He's running in a primary where voters are much less interested in this," said Blendon.
"He hasn't talked about health much," added Drew Altman, president of the Kaiser Family Foundation.
Romney spokesman Kevin Madden said the omission of health care from TV ads isn't a deliberate slight, that voters ask about it frequently at town hall meetings and that Romney talks about the principles he applied in Massachusetts, such as maintaining privately run insurance.
He did say, however, that Romney doesn't want to apply the Massachusetts model to the country.
"This is not a federal proposal," he said. "Governor Romney believes this particular approach works well for one state, and states should be given the flexibility they need to be innovative in their effort to expand access to care while making it more affordable."
Indeed, compared to a state such as California, which also is weighing a health care overhaul, Massachusetts had half the rate of uninsured people and more money per capita in a ready pool set aside for emergency room care.
Altman of Kaiser said the country can learn from Massachusetts and that it's not enough to say each state has to find its own solution.
"Momentum for reform will turn on what happens in Massachusetts," Altman said. "It may be possible to find ways to build a coalition to cut through the impasse.
"But we can't reform the health care system and solve our big problems state by state. Not enough states have the resources or political will like they did in Massachusetts."
HOW THE MASSACHUSETTS PLAN WORKS:
How many uninsured: About 400,000, or 9 percent of population.
Mandate: State law requires everyone to have health insurance. Similar to requiring drivers to have auto insurance.
What about people with no money? The poor can get Medicaid.
What if they make some money but not enough to afford insurance?
A single adult making less than $40,000 gets help. For example, a typical 37-year-old person making $30,000 a year can buy state-subsidized insurance for about $105 a month.
What if they make more: Those making more than $40,000 ($60,000 for family of four) don't get taxpayer help. A typical 37-year-old adult making $42,000 would pay $259 a month for a policy with $5,000 deductible.
Who pays for the subsidies: A fund financing emergency room care now for the uninsured, plus cash from state and federal governments and fees paid by any business with 11-plus workers that refuses to provide insurance
Source: The Kaiser Family Foundation, Harvard School of Public Health and Mitt Romney campaign
WHAT PEOPLE THINK
In Massachusetts, there's growing support for the new plan.
June 2007 - Approve: 67 percent
September 2006 - Approve: 61 percent
Should government require people to get health insurance?
Democrats: 79 percent support, 17 percent oppose
Independents: 59 percent support, 33 percent oppose
Republicans: 44 percent support, 53 percent oppose
Source: The national poll for the Kaiser Family Foundation and the Harvard School of Public Health surveyed 1,867 adults Nov. 9-19, 2006, and had a margin of error of plus or minus 3 percentage points.
The Massachusetts poll of 1,003 adults was conducted May 29 to June 10 and had a margin of error of plus or minus 4 percentage points.